Genetic Counseling: An Integral Part of the Modern Lab
Megan Maxwell shares insights into her career in genetic counseling, a rapidly expanding laboratory discipline
Michael Schubert, PhD, is a veteran science and medicine communicator. He holds graduate degrees in biochemistry and molecular biology with a research focus on chromatin structure and function and has written on subjects from subspeciality pathology to fictional science. In addition to writing and editing, he is co-director of the Digital Communications Fellowship in Pathology and Course Trainer at the Lightyear Foundation, an initiative aimed at making science accessible to all.
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Megan Maxwell, MS, LCGC, is a licensed and certified genetic counselor with 15 years of experience in the field, 10 of which have been dedicated to laboratory-based genetic counseling.
As the availability and use of molecular diagnostics continues to grow,1 genetic counselors are playing an increasingly important role in test stewardship and utilization management.2 Today’s Clinical Lab spoke to Megan Maxwell, a genetic counselor and manager of genetics operations for University Health in San Antonio, Texas, about her career path, her experience in laboratory and clinical settings, and the future of the laboratory genetic counseling field.
What inspired you to become a laboratory genetic counselor?
I was on a pre-med track as an undergraduate student, but the training requirements for a career as a physician weren’t conducive to the way I envisioned living my adult life. My advisor’s suggestion to instead pursue a career in nursing or genetic counseling rang a bell—my high school biology teacher had also recommended genetic counseling because she knew I was good at genetics—and I decided that’s what I wanted to do. Genetic counseling, which involves a two-year postgraduate commitment with integrated internships and a terminal Master’s degree, aligned much better with my vision for my life.
How did I end up as a laboratory genetic counselor, specifically? Well, there are different approaches to clinical genetic counseling. One is heavily focused on the psychosocial elements of the consultation; I find that a lot of clinical counselors favor that approach. I was always more focused on the educational component, though, which made me realize that my personality was probably better suited for laboratory genetic counseling. You get to be like the Wizard of Oz behind the curtain—there’s not a lot of direct patient contact, but you still help make decisions that ensure everyone receives the best possible care.
What are some of the key challenges you’ve faced?
One of my biggest challenges has been trying to reframe the view people have of utilization management as an obstruction. So many people think utilization management is all about budget and resource conservation, so it took some time for a few of the more skeptical providers here at University Health to recognize that we really are on the same team. But working together builds trust. The more I work with clinicians, the more they see that our collaboration achieves diagnoses that otherwise would not have been achieved without such a relationship, and the more test selection becomes a dialogue. We all want what’s best for the patient—and that means compromising and deferring to each other’s expertise to come up with a consensus decision that is in the patient’s best interests.
How has your role changed in your five years at University Health?
When I initially came on as a sole operator, the majority of my role was indirect patient care—clinician consults, chart reviews, and building a system for utilization management.
Once everything was set up, we started growing. Now, we have two operations support specialists and two junior genetic counselors. I’m still involved in some of the case management because that’s where my passion lies, but as we’ve grown, I’ve also had to transition more and more into a management role.
What do you think lies ahead for genetic counseling?
It’s definitely a field with job security! Medicine is increasingly moving in the direction of genetics. We don’t want to treat only the symptoms; we want to treat the disease itself. Genetic utilization increases by about 15 to 20 percent annually—which is one of the reasons the team has evolved so fast—and I wouldn’t be surprised if that increases over the next few years to something like 40 percent annually. I envision more rapid growth of the team and expansion into other disciplines like hematopathology and infectious disease. Overall, I think genetics is going to become a bigger part of Pathology Services than the Lab Utilization Advisory Subcommittee anticipated in 2017 when the idea first arose. I think, eventually, it’s going to be a much more integral and interwoven part of the lab than anyone imagined.
References:
- Halbisen AL, Lu CY. Trends in availability of genetic tests in the United States, 2012–2022. J Pers Med. 2023;13(4):638. doi:10.3390/jpm13040638.
- Kieke MC et al. The current landscape of genetic test stewardship: a multi-center prospective study. J Genet Couns. 2021;30(4):1203–1210. doi:10.1002/jgc4.1403.
